scholarly journals A descriptive analysis of end-of-life discussions for high-grade glioma patients

2021 ◽  
Author(s):  
Ai Chikada ◽  
Sayaka Takenouchi ◽  
Yoshiki Arakawa ◽  
Kazuko Nin
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Patient Participation ◽  
High Grade Glioma ◽  
Team Approach ◽  
High Grade ◽  
Care Providers ◽  
Patient Goals ◽  
Significant Difference ◽  
Eol Care

Abstract Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher’s exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient’s wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.

Are Health-Care Providers Well Prepared in Providing Optimal End-of-Life Care to Critically Ill Patients? A Cross-Sectional Study at a Tertiary Care Hospital in the United States

2018 ◽  
Vol 35 (10) ◽  
pp. 1080-1094 ◽  
Author(s):  
Kartikeya Rajdev ◽  
Nina Loghmanieh ◽  
Maria A. Farberov ◽  
Seleshi Demissie ◽  
Theodore Maniatis
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
The United States ◽  
Care Providers ◽  
Strongly Agree ◽  
Eol Care

It is important for health-care providers to be comfortable in providing end-of-life (EOL) care to critically ill patients and realizing when continuing aggressive measures would be futile. Therefore, there is a need to understand health-care providers’ self-perceived skills and barriers to providing optimum EOL care. A total of 660 health-care providers from medicine and surgery departments were asked via e-mail to complete an anonymous survey assessing their self-reported EOL care competencies, of which 238 responses were received. Our study identified several deficiencies in the self-reported EOL care competencies among health-care providers. Around 34% of the participants either disagreed (strongly disagree or disagree) or were neutral when asked whether they feel well prepared for delivering EOL care. Around 30% of the participants did not agree (agree and strongly agree) that they were well prepared to determine when to refer patients to hospice. 51% of the participants, did not agree (agree and strongly agree) that clear and accurate information is delivered by team members to patients/family. The most common barrier to providing EOL care in the intensive care unit was family not accepting the patient’s poor prognosis. Nursing staff (registered nurse) had higher knowledge and attitudes mean competency scores than the medical staff. Attending physicians reported stronger knowledge competencies when compared to residents and fellows. More than half of the participants denied having received any previous training in EOL care. 82% of the participants agreed that training should be mandatory in this field. Most of the participants reported that the palliative care team is involved in EOL care when the patient is believed to be terminally ill. Apart from a need for a stronger training in the field of EOL care for health-care providers, the overall policies surrounding EOL and palliative care delivery require further evaluation and improvement to promote better outcomes in caring patients at the EOL.

Self-Perceived End-of-Life Care Competencies of Health-Care Providers at a Large Academic Medical Center

2018 ◽  
Vol 35 (11) ◽  
pp. 1409-1416 ◽  
Author(s):  
Marcos Montagnini ◽  
Heather M. Smith ◽  
Deborah M. Price ◽  
Bidisha Ghosh ◽  
Linda Strodtman
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Care Providers ◽  
Academic Medical ◽  
Eol Care

Background: In the United States, most deaths occur in hospitals, with approximately 25% of hospitalized patients having palliative care needs. Therefore, the provision of good end-of-life (EOL) care to these patients is a priority. However, research assessing staff preparedness for the provision of EOL care to hospitalized patients is lacking. Objective: To assess health-care professionals’ self-perceived competencies regarding the provision of EOL care in hospitalized patients. Methods: Descriptive study of self-perceived EOL care competencies among health-care professionals. The study instrument (End-of-Life Questionnaire) contains 28 questions assessing knowledge, attitudes, and behaviors related to the provision of EOL care. Health-care professionals (nursing, medicine, social work, psychology, physical, occupational and respiratory therapist, and spiritual care) at a large academic medical center participated in the study. Means were calculated for each item, and comparisons of mean scores were conducted via t tests. Analysis of variance was used to identify differences among groups. Results: A total of 1197 questionnaires was completed. The greatest self-perceived competency was in providing emotional support for patients/families, and the least self-perceived competency was in providing continuity of care. When compared to nurses, physicians had higher scores on EOL care attitudes, behaviors, and communication. Physicians and nurses had higher scores on most subscales than other health-care providers. Conclusions: Differences in self-perceived EOL care competencies were identified among disciplines, particularly between physicians and nurses. The results provide evidence for assessing health-care providers to identify their specific training needs before implementing educational programs on EOL care.

scholarly journals Ethical Considerations in End-of-Life Discussions

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Code Of Ethics ◽  
Direct Result ◽  
Care Providers ◽  
Ethical Considerations ◽  
Beliefs And Values ◽  
Nurses And Physicians ◽  
Eol Care ◽  
Dying Patient

Every person deserves a dignified death. What this entails varies dramatically from patient to patient. Most people, however, never discuss their wishes regarding the care they desire for this very personal, final journey. As technology improves, as well as the ability to successfully treat almost any condition, both patients and clinicians alike have begun to ignore the reality of death. In this paper, the term clinicians will refer to doctors and nurses. In our present culture discussing death has become taboo. Patients may think about the end of their lives but are unsure or uncomfortable broaching the topic with their medical staff and families. Additionally, many clinicians are uneasy with end-of-life (EOL) discussions and, consequently, avoid them entirely. It is, however, the ethical responsibility of health care providers to address their patient’s wishes regarding EOL care. Clinicians need to take the initiative to begin the conversation regarding prognosis and care choices. They need to make the patients feel that they can comfortably discuss this delicate issue without fear of judgment, pressure, or the possibility of abandonment. Ethical dilemmas are common when caring for a dying patient, often a direct result of avoiding or delaying difficult, EOL conversations [1]. By not adequately preparing patients for the dying process, clinicians are in danger of ignoring the ethical principles of autonomy, justice, beneficence and non-maleficence. Nurses and physicians alike share this responsibility, although nurses have historically shied away from this obligation. The American Nurses Association (ANA), the premier nursing organization representing registered nurses throughout the U.S., leaves no doubt that it is nurses’ ethical duty to assure that patients have a dignified death - one that respects their spiritual, emotional, and physical needs, as well as those of their families. This duty is spelled out in the Nursing Code of Ethics. Nurses are called on to identify barriers that prevent early EOL discussions with patients so that they may work to eliminate them and ultimately improve the patient’s ethical rights to a good death. Nurses should challenge themselves to break through these barriers to ensure that patients are able to die in a manner consistent with their beliefs and values.

Knowledge, Attitudes, and Beliefs of Physicians and Other Health Care Providers Regarding Artificial Nutrition and Hydration at the End of Life

2018 ◽  
Vol 31 (7) ◽  
pp. 1121-1133 ◽  
Author(s):  
Roschelle Heuberger ◽  
Helen Wong
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Artificial Nutrition ◽  
Attitudes And Beliefs ◽  
Care Providers ◽  
Advanced Dementia ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Eol Care

Objective: Despite the growing evidence against artificial nutrition and hydration (ANH) use among patients with advanced dementia, little is known about the perspectives of the health care team. This study examined the knowledge, attitudes, and beliefs of physicians and other health care providers regarding the use of ANH at the end of life (EOL). Methods: A cross-sectional survey explored the provision of EOL care using a hypothetical case scenario of a patient with advanced dementia and dysphagia. Questionnaire items were analyzed using parametric and nonparametric approaches. Results: In this sample of 323 respondents, statistical significance was found between physicians and other health care providers’ views on ANH and its related beneficial effects or health outcomes in EOL care. Discussion: Results indicate knowledge deficits in physicians and other health care professionals and highlight the need for comprehensive continuing education programs on EOL topics. Conclusion: Differences in knowledge, attitudes and beliefs regarding ANH in EOL among healthcare providers were observed and education regarding evidence based clinical guidelines are necessary.

End-of-life discussions with noncurable lung cancer patients: A patients' and oncologists' qualitative study.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 151-151
Author(s):  
Olivier Huillard ◽  
Pascale Vinant ◽  
Isabelle Colombet ◽  
Vincent Montheil ◽  
Marie Yvonne Guillard ◽  
...  
Keyword(s):  
Qualitative Study ◽  
End Of Life ◽  
Health Care Providers ◽  
Structured Interview ◽  
Care Providers ◽  
Lung Cancer Patients ◽  
Attitudes And Practices ◽  
Expected Benefits ◽  
Eol Care ◽  
Depth Interviews

151 Background: Discussions concerning patients’ (pts) preferences regarding end-of-life (EOL) care can improve the quality of care in non-curable-cancer-pts. Nevertheless having such discussions is difficult for health care providers and discrepancies exist regarding the frequency of such discussions. Methods: We conducted a single center qualitative study exploring oncologists’ attitudes and practices toward EOL discussions and the feasibility of an intervention designed to explore and collect pts’ preferences regarding EOL care. For oncologists, the intervention consisted in a semi structured interview and in a questionnaire concerning pts included. For pts, semi-structured-in-depth-interviews were conducted to assess their opinion about EOL discussions and the feasibility of exploring and collecting their preferences regarding EOL care in our practice setting. Resulting anxiety was measured. Results: Oncologists’ interviews (n=5), revealed that EOL discussions were rare, more likely to be initiated by pts and to arise lately in the evolution of the disease. Main barriers invoked were the difficulty of having such conversation, the limited time available, the risks of maleficence (mainly anxiety and loss of hope) and the uncertainty concerning expected benefits. Pts’ interviews (n=10) revealed that most of them were willing to be part of medical decisions concerning their EOL care. Few preferences regarding EOL-care were actually collected but the resulting in-depth discussions help mentioning a great variety of unusual topics as well as emotional, cultural and spiritual issues. Anxiety as a side effect was uncommon. Interviewers and oncologists often overestimated pts’ anxiety which is consistent with a projection of their own anxiety. Conclusions: Discussions concerning EOL care are uncommon in the setting studied and four main barriers were identified. Having these conversations was feasible and led to unexpected in-depth interviews concerning topics rarely addressed in our current practice. This intervention could help clarifying pts’ preferences and identifying psychosocial issues that could trigger palliative care team referral.

scholarly journals Caregiver-Reported Barriers to Quality End-of-Life Care in Dementia With Lewy Bodies: A Qualitative Analysis

2020 ◽  
Vol 37 (9) ◽  
pp. 728-737
Author(s):  
Melissa J. Armstrong ◽  
Slande Alliance ◽  
Pamela Corsentino ◽  
Susan M. Maixner ◽  
Henry L. Paulson ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Dementia With Lewy Bodies ◽  
Skilled Nursing Facility ◽  
Lewy Bodies ◽  
The United States ◽  
Care Providers ◽  
Skilled Nursing ◽  
Eol Care

Objective: This study investigated barriers to quality end-of-life (EOL) care in the context of dementia with Lewy bodies (DLB), one of the most common degenerative dementias in the United States. Methods: The study consisted of telephone interviews with caregivers and family members of individuals who died with DLB in the last 5 years. Interviews used a semi-structured questionnaire. Investigators employed a qualitative descriptive approach to analyze interview transcripts and identify common barriers to quality EOL care. Results: Thirty participants completed interviews. Reported barriers to quality EOL experiences in DLB pertained to the DLB diagnosis itself and factors relating to the US health-care system, facilities, hospice, and health-care providers (physicians and staff). Commonly reported barriers included lack of recognition and knowledge of DLB, lack of education regarding what to expect, poor coordination of care and communication across health-care teams and circumstances, and difficulty accessing health-care resources including skilled nursing facility placement and hospice. Conclusion: Many identified themes were consistent with published barriers to quality EOL care in dementia. However, DLB-specific EOL considerations included diagnostic challenges, lack of knowledge regarding DLB and resultant prescribing errors, difficulty accessing resources due to behavioral changes in DLB, and waiting to meet Medicare dementia hospice guidelines. Improving EOL experiences in DLB will require a multifaceted approach, starting with improving DLB recognition and provider knowledge. More research is needed to improve recognition of EOL in DLB and factors that drive quality EOL experiences.

A Systematic Review of Clinical Interventions Facilitating End-of-Life Communication Between Patients and Family Caregivers

2020 ◽  
Vol 38 (2) ◽  
pp. 180-190
Author(s):  
Min Young Jung ◽  
Alicia K. Matthews
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Medical Condition ◽  
Optimal Timing ◽  
Care Providers ◽  
Eligibility Criteria ◽  
Manual Search ◽  
Eol Care

Communication between patients and family caregivers plays a key role in successful end-of-life (EOL) care. In the majority of cases, health-care providers (HCP) are responsible for leading this communication in clinical settings. This systematic review aimed to examine the evidence for the efficacy of HCP-led interventions in enhancing communication between patients and family caregivers. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a search of MEDLINE via PubMed, CINAHL, Scopus, Embase, and PsycINFO as well as a manual search for additional articles on Google Scholar without date restrictions. Of 2955 articles retrieved, 8 meeting the eligibility criteria were included in the review. A quality appraisal of the selected studies was performed using the van Tulder Scale, with 5 of 8 studies rated as high quality. All 8 studies employed psychoeducational interventions involving both patients and surrogate/family caregivers. Common elements of the interventions reviewed included encouraging participant dyads to share their concerns about the patient’s medical condition, clarify their goals and values for EOL care, and discuss their EOL care preferences. Of 8 interventions reviewed, 6 measured EOL care preference congruence within dyads as a primary outcome, and all 6 interventions were effective in increasing congruence. Secondary outcomes measured included decisional conflict and relationship quality, with mixed outcomes reported. This review suggests that HCP-led EOL communication interventions show promise for improving EOL care preference congruence. However, further studies with improved methodological rigor are needed to establish the optimal timing, intensity, and duration of interventions.

Decision-Making of Patients With Implantable Cardioverter-Defibrillators at End of Life: Family Members’ Experiences

2016 ◽  
Vol 34 (6) ◽  
pp. 518-523 ◽  
Author(s):  
Mei Ching Lee ◽  
Daniel P. Sulmasy ◽  
Joseph Gallo ◽  
Joan Kub ◽  
Mark T. Hughes ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
End Of Life ◽  
Health Care Providers ◽  
Family Members ◽  
Implantable Cardioverter Defibrillators ◽  
Care Providers ◽  
End Stage ◽  
Eol Care ◽  
Cardioverter Defibrillators

Introduction: Many patients with advanced heart failure (HF) experience the life-extending benefits of implantable cardioverter-defibrillators (ICD), but at the end stage of HF, patients may experience shocks with increasing frequency and change the plan for end-of-life (EOL) care including the deactivation of the ICD. This report describes family members’ experiences of patients with ICD making decisions at EOL. Understanding the decision-making of patients with ICD at EOL can promote informed decision-making and improve the quality of EOL care. Methods: This pilot study used a mixed methods approach to test the effects of a nurse-guided discussion in decision-making about ICD deactivation (turning off the defibrillation function) at the EOL. Interviews were conducted, audiotaped, and transcribed in 2012 to 2013 with 6 family members of patients with advanced HF and ICDs. Three researchers coded the data and identified themes in 2014. Results: Three main themes described family members’ experiences related to patients having HF with ICDs making health-care decision at EOL: decision-making preferences, patients’ perception on ICD deactivation, and communication methods. Discussion: Health-care providers need to have knowledge of patients’ decision-making preferences. Preferences for decision-making include the allowing of appropriate people to involve and encourages direct conversation with family members even when advance directives is completed. Information of ICD function and the option of deactivation need to be clearly delivered to patients and family members. Education and guidelines will facilitate the communication of the preferences of EOL care.

The Interaction of Pulmonary Physiology and Swallowing: A Juggling Act for the Physician and Speech-Language Pathologist

2009 ◽  
Vol 18 (1) ◽  
pp. 34-40
Author(s):  
Karen J. Dikeman ◽  
Marta S. Kazandjian ◽  
Elbert Tun ◽  
Panina Niyazova ◽  
Tien-Tsai Tsai ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Condition ◽  
Team Approach ◽  
Care Providers ◽  
Geriatric Population ◽  
Pulmonary Physiology ◽  
Speech Language Pathologist ◽  
Ventilator Dependence ◽  
Clinical Case Studies ◽  
Single Disease Entity

Abstract Patients who are dependent upon tracheostomy and/or ventilator use present a particular challenge to health-care providers. The interaction of pulmonary physiology and deglutition is complex, as illustrated in the course of patients who are in the weaning process. Speech language pathologists (SLPs) should work closely with their physician colleagues to understand the influence of multiple medical co-morbidities on intervention. In traditional medicine, the clinician's objective is to connect a patient's many symptoms and complaints to a single disease entity. However, in caring for the ventilator dependent geriatric population, a symptom such as dysphagia typically results from the interplay of various, multi-organ symptoms, and conditions. This article strives to demonstrate the “juggling act” that the physician and SLP must balance between the patient's current medical condition, pulmonary dysfunction, and disordered swallowing. Clinical case studies illustrate the benefit of swallowing intervention on quality of life. While the care of patients with tracheostomy and ventilator dependence requires a team approach, with respiratory therapy and nursing vital members, this article emphasizes the roles of the SLP and physician.

scholarly journals The Role of Obesity in Predicting the Clinical Outcomes of COVID-19

Obesity Facts ◽  
2021 ◽  
pp. 1-9
Author(s):  
Serdar Sahin ◽  
Havva Sezer ◽  
Ebru Cicek ◽  
Yeliz Yagız Ozogul ◽  
Murat Yildirim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Health Care Providers ◽  
Study Groups ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Care Providers ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D

<b><i>Introduction:</i></b> The aim of this was to describe the predictors of mortality related to COVID-19 infection and to evaluate the association between overweight, obesity, and clinical outcomes of COVID-19. <b><i>Methods:</i></b> We included the patients &#x3e;18 years of age, with at least one positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction. Patients were grouped according to body mass index values as normal weight &#x3c;25 kg/m<sup>2</sup> (Group A), overweight from 25 to &#x3c;30 kg/m<sup>2</sup> (Group B), Class I obesity 30 to &#x3c;35 kg/m<sup>2</sup> (Group C), and ≥35 kg/m<sup>2</sup> (Group D). Mortality, clinical outcomes, laboratory parameters, and comorbidities were compared among 4 groups. <b><i>Results:</i></b> There was no significant difference among study groups in terms of mortality. Noninvasive mechanical ventilation requirement was higher in group B and D than group A, while it was higher in Group D than Group C (Group B vs. Group A [<i>p</i> = 0.017], Group D vs. Group A [<i>p</i> = 0.001], and Group D vs. Group C [<i>p</i> = 0.016]). Lung involvement was less common in Group A, and presence of hypoxia was more common in Group D (Group B vs. Group A [<i>p</i> = 0.025], Group D vs. Group A [<i>p</i> &#x3c; 0.001], Group D vs. Group B [<i>p</i> = 0.006], and Group D vs. Group C [<i>p</i> = 0.014]). The hospitalization rate was lower in Group A than in the other groups; in addition, patients in Group D have the highest rate of hospitalization (Group B vs. Group A [<i>p</i> &#x3c; 0.001], Group C vs. Group A [<i>p</i> &#x3c; 0.001], Group D vs. Group A [<i>p</i> &#x3c; 0.001], Group D vs. Group B [<i>p</i> &#x3c; 0.001], and Group D vs. Group C [<i>p</i> = 0.010]). <b><i>Conclusion:</i></b> COVID-19 patients with overweight and obesity presented with more severe clinical findings. Health-care providers should take into account that people living with overweight and obesity are at higher risk for COVID-19 and its complications.

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